Talk:Low-level laser therapy

title?

Should the title of the article not be "Low Level Laser Therapy" as opposed to "Photobiomodulation"? If they refer to the same concept, there are far more citations to the former on pubmed.—The preceding unsigned comment was added by 216.185.64.86 (talk • contribs) 13:17, August 24, 2006.

Possible sources

• Karu, T, T (1999). "Primary and secondary mechanisms of action of visible to near-IR radiation on cells". J Photochem Photobiol B 1999 Mar 49(1) 1-17. 49 (1): 1–17. doi:10.1016/S1011-1344(98)00219-X. PMID 10365442.
• Lane N., N (2006). "Power Games". Nature. 2006 Oct 26;443(7114):901-3. 443 (7114): 901–3. doi:10.1038/443901a. PMID 17066004.

Moved from Roxy's talk page

Changes made to LLLT page only included missing information. Regarding reimbursement, Blue Cross Blue Shield Association has changed their policy to indicate that LLLT is considered 'medically necessary'. Plenty more can be cited if further evidence is required. The treatment of Oral Mucositis included citations from multiple papers, including a systematic review and is further supported by the policy changes by Blue Cross Blue Shield Association. The Blue Cross Blue Shield of Western New York medical policy states this (emphasis mine):

"A recent systematic review of RCTs on LLLT for prevention of oral mucositis included 18 RCTs, generally considered at low risk of bias, and found statistically significantly better outcomes with LLLT than control conditions on primary and secondary outcomes. In addition, three double-blind, RCTs published in 2015 found significantly better outcomes in patients undergoing LLLT than undergoing sham treatment prior to or during cancer treatment. The evidence is sufficient to determine qualitatively that the technology results in a meaningful improvement in the net health outcome."

Please review changes and tell me which content you feel is not supported by the citations and evidence.

edit: in case you are concerned about the use of static PDFs, you can search Blue Cross Blue Shield of Western New York's medical policy here, look for Low Level User therapy, you can do the same for Blue Cross Massachusetts and Blue Kansas City.

Academia salad (talk) 11:43, 6 February 2018 (UTC)

the above was posted at my talk page. -Roxy, the dog. barcus 14:26, 6 February 2018 (UTC)

Hm, there are some useful refs there, and some not useful ones. Will look more later. There are some things here to work with. Jytdog (talk) 15:49, 6 February 2018 (UTC)

I reverted the recent change to the article, as briefly hinted by my edsum, because of the clear WP:COI of the editor, and the fact that they are a WP:SPA editor. The edits appear designed to promote the business of the editor concerned. Furthermore, I fail to see the relevance of the reimbursements portions to an encyclopeadia article. The article is also a mish mash of apparent misinterpretation, contradictions and contraindications which only serve to confuse, and needs a good broom. Mr Salad, have you ever read WP:MEDRS? -Roxy, the dog. barcus 23:08, 6 February 2018 (UTC)

I agree that the page needs a good spring clean. I had not read WP:MEDRS, but a quick scan suggests that secondary sources are preferred over primary sources, which makes sense. I’ll read it more carefully when I get the time. In the meantime, here is a systematic review published in the peer reviewed Supportive Care in Cancer on oral mucositis, a systematic review published in the peer reviewed journal The Lancet about the management of neck pain, and a systematic review in the peer reviewed BMC on interventions in osteoarthritic knee pain. I didn’t add the reimbusement section, I just updated it. I understand concerns over COI, I'm happy to limit my activity to discussion on this Talk page. Academia salad (talk) 14:15, 7 February 2018 (UTC)

you got it on MEDRS. We summarize what high quality secondary sources say - reviews in good journals, statements by major medical/scientific bodies are best. We reach for things like insurance company evaluations when there are not other good secondary sources (we can count on the insurance folks to be critical and independent of manufacturers, at least). If you want to take a shot at proposing content based on the refs that fit the bill, to update the content, that would be amazing. Jytdog (talk) 03:55, 9 February 2018 (UTC)

I'd be happy to, but I could use some guidance. One of the problems with reporting from all the sources is that a lot of them don’t take dosage into account when reviewing evidence. Dosage is critical to the efficacy of LLLT/PBMT. This is well put in a systematic review in the Lancet, where they say "effectiveness depends on factors such as wavelength, site, duration, and dose of LLLT treatment. Adequate dose and appropriate procedural technique are rarely considered in systematic reviews", but it is also addressed in "Meta-analysis of pain relief effects by laser irradiation on joint areas.", "Low level laser treatment of tendinopathy: a systematic review with meta-analysis.", and "A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders." However I don't feel I should just cut out papers that do not account for dosage. Do you have any recommendations?

--Academia salad (talk) 15:51, 15 February 2018 (UTC)

Tricky. per MEDMOS we generally don't do discuss dosing in order to avoid becoming an instruction manual. But in this case where dosing is crucial (it is "low level LT" after all) something in the "medical use" section mentioning how dose plays into efficacy and safety, sourced to those MEDRS refs, would be fine. With regard to refs that omit dosing, are you are aware of discussion in the biomedical literature where people who don't take those things into account, justify not taking them into account?

In general it is true with all medical procedures that the skill of the physician (referring to "proper technique") is by far the biggest factor determining outcomes. This is not surprising and efficacy and safety should take into account how the procedure is done "in the wild", by experts and novices and middle-experienced people -- anybody who does it. Jytdog (talk) 16:32, 15 February 2018 (UTC)

I am not aware of any papers that justify not taking dosage into account, but there are papers and reviews that acknowledge that dose should have been taken into account. It is not difficult to find some of these papers as examples and I could provide some examples. A good example of the specific concern I have is the paper "Is low-level laser therapy in relieving neck pain effective? Systematic review and meta-analysis.”, which is currently cited on the Wikipedia page as evidence against the effectiveness of LLLT.

The paper by Kadhim-Saleh et al. was rebutted by the authors of the original paper "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials", in "Methodological shortcomings make conclusion highly sensitive to relevant changes in review protocol”, citing specific problems with the paper, including that "Kadhim-Saleh et al. appeared to give no serious consideration to the appropriateness of LLLT technique including dosage a priori in selection criteria or analysis protocol." and "They cited meta-analyses published over 20 years ago to demonstrate the consistency of their claim with previous reviews that found no effect from LLLT despite 80–90 % of RCTs on LLLT being published after these citations." I would strongly recommend reading all three papers, but then paper by Kadhim-Saleh et al. is not a paper I would include on the wikipedia page.

I was wondering what the best practice is for cases like that? Academia salad (talk) 10:23, 20 February 2018 (UTC)

References